Provider Demographics
NPI:1073020848
Name:GOVENDO, NANCE
Entity Type:Individual
Prefix:
First Name:NANCE
Middle Name:
Last Name:GOVENDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MERGANSER WAY
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-4349
Mailing Address - Country:US
Mailing Address - Phone:508-668-1910
Mailing Address - Fax:
Practice Address - Street 1:27 MERGANSER WAY
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-4349
Practice Address - Country:US
Practice Address - Phone:508-668-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical